Last-minute delivery shortfalls and unexpected regulatory obstacles are a wearingly familiar feature of the Covid-19 vaccination campaign. Once again this week, a failure by AstraZeneca to deliver on its already-reduced volume commitments for this month as well as a smaller-than-expected shipment from Johnson & Johnson have forced the Health Service Executive (HSE) to revise its plans in real time. The HSE had already been scrambling to work out the practical consequences of the National Immunisation Advisory Committee's (Niac) decisions, after lengthy deliberations, to recommend use of the one-shot Johnson & Johnson vaccine for over-50s and to set the same age threshold for the AstraZeneca vaccine (the committee had previously advised that the latter be used for over-60s).
Those cautious recommendations were based on Niac’s balancing of the risks arising from a very small number of serious cases of blood clots apparently linked to adenovirus vaccines. But they also appear calibrated to have the least possible effect on progress in the vaccination campaign. For example, by limiting the Johnson & Johnson vaccine in effect to people aged 50-59 years, Niac has landed on a population cohort whose size (609,000, according to CSO estimates for 2020) matches almost exactly the expected deliveries of that vaccine in the second quarter (605,000). Some in that group will already have received a dose due to their health conditions, leaving surplus shots for harder-to-reach communities such as Travellers, Roma and the homeless. That’s the theory at least. In practice, it sounds too neat; already the shortfall in Johnson & Johnson deliveries show as much.
Nonetheless, Niac’s decisions, while causing huge headaches for the HSE, just about keep open the possibility that the Government’s target of vaccinating 80 per cent of adults by the end of June could be achieved. There are two obstacles standing in the way. The first is supply, which is now largely outside the State’s control. The second is that increasingly large volumes of vaccines look likely to arrive in the latter part of the third quarter, putting huge pressure on the State’s ability to get shots into arms at current speeds.
The State’s plan originally envisaged administering 250,000 vaccines a week by this stage. Last week it reached 190,000 – an impressive number, and one determined by supply, but not high enough. At current weekly growth rates, the programme is two weeks off track. That means that if the 80 per cent first-dose coverage target is to be reached, the HSE would have to administer close to 450,000 doses a week by the middle of June. The question is whether the national vaccination infrastructure can accommodate such large volumes. The Government has a few weeks to make that it can.